Thousands Of Consumers Get Insurance Cancellation Notices Due To Health Law Changes
Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies.
By all accounts, the new policies will offer consumers better coverage, in some cases, for comparable cost -- especially after the inclusion of federal subsidies for those who qualify. The law requires policies sold in the individual market to cover 10 “essential” benefits, such as prescription drugs, mental health treatment and maternity care. In addition, insurers cannot reject people with medical problems or charge them higher prices. The policies must also cap consumers’ annual expenses at levels lower than many plans sold before the new rules.
But the cancellation notices, which began arriving in August, have shocked many consumers in light of President Barack Obama’s promise that people could keep their plans if they liked them.
“I don’t feel like I need to change, but I have to,” said Jeff Learned, a television editor in Los Angeles, who must find a new plan for his teenage daughter, who has a health condition that has required multiple surgeries.
http://www.kaiserhealthnews.org/Stories/2013/October/21/cancellation-notices-health-insurance.aspx
New Front in the Fight With Infant Mortality
By EDUARDO PORTER
As the health care bill that was to become known as Obamacare was making its way through Congress in 2009, Senator Jon Kyl, Republican of Arizona, sought to block the requirement that health insurers cover a minimum set of health benefits determined by the federal government.
“I don’t need maternity care,” said Senator Kyl, who retired from the Senate last year at the age of 70. “Requiring that on my insurance policy is something that I don’t need and will make the policy more expensive.”
Mr. Kyl’s proposed amendment embodied the conservative view: The Affordable Care Act that passed Congress in 2010 is an unacceptable intrusion into the private decisions of American families and businesses.
The Senate Finance Committee, by a vote of 14 to 9, rejected the amendment, opting for a different approach that could change, in subtle but profound ways, the nature of the American social contract.
Pregnant women, across the country and anywhere along the income spectrum, will for the first time have guaranteed access to health insurance offering a minimum standard of care that will help keep their babies alive.
The benefit may seem narrow. But it offers the best opportunity in a generation to tackle one of the United States’ most notorious stigmas: an intractably high infant mortality rate that hardly fits one of the richest, most technologically advanced nations on earth. If it succeeds, it could provide Americans with an alternative view of how government can serve society.
I have brought up infant mortality before as a marker of the drawbacks inherent in the United States’ model of relatively low taxes and modest government, leaving more social outcomes to the sway of market forces.
The United States was not always at the bottom of the charts. Four decades ago, Americans lost proportionately fewer babies than average among industrialized nations. The United States lost more than France but fewer than Germany, more than Sweden but fewer than Luxembourg.
By 2010, however, virtually every other advanced country had surpassed the United States. In Portugal, 2.5 babies out of every 1,000 born alive died before they were a year old. In Finland and Japan the figure was 2.3. Though the United States has made progress recently, it still lost 6.1. Among members of the Organization for Economic Cooperation and Development, only Mexico, Chile and Turkey did worse.
The Bad News for Local Job Markets
By AARON K. CHATTERJI
DURHAM, N.C. — THE September jobs numbers, finally released this week after the government reopened, indicate that the job market remains on a painfully slow upward trajectory. Unemployment has fallen a full percentage point since early 2012, but at this pace, our economy could still be years away from its prerecession level. To make faster progress, many analysts are banking on job growth from two key sectors, education and health care.
“Ed and meds” have already accounted for a significant share of employment growth over the past several years. More important, these jobs are the only thing keeping many small and midsize American cities from sliding into deeper decline. Several regions are consciously building around these services under the logic that they cannot be outsourced, and local demand will continue to grow. Unfortunately, both assumptions are wrong, and that could mean bad news for many local job markets around the country.
Education and health care jobs are so attractive because unlike manufacturing jobs, which have steadily declined over the last 25 years, they are largely shielded from global competition. As a society we continue to spend large sums of money, both in the public and private sector, on educating our students and caring for the health of our citizens. Since good jobs will increasingly require more education and our population is aging, the long-term outlook for these sectors looks positive. Education and health care also create jobs across income distribution, providing work for home health aides as well as college professors.
However, while the total number of jobs in these sectors could grow, it is not likely that all regions would benefit equally. For example, one might take for granted that there will be growing demand for orthopedic surgeons in Toledo, Ohio, and educational administrators in Iowa City. But the same forces that led other industries to cluster in specific regions (think technology in Silicon Valley or banking in New York) are now sweeping through education and health care.
In White House Pitches, Rosy View of Health Care Site
By MICHAEL D. SHEAR and SHERYL GAY STOLBERG
WASHINGTON — Just days before HealthCare.gov went live with disastrous results, top White House officials were excitedly briefing lawmakers, reporters, Capitol Hill staff members and Washington pundits on their expectations for the government’s new health care Web site.
Led by David Simas, a senior communications adviser in the West Wing, and sometimes joined by Denis McDonough, the White House chief of staff, and others, the fast-paced PowerPoint briefings showed images of a shiny new Web site that was elegantly designed, simple to use and ready for what officials hoped would eventually be a flood of customers on Oct. 1. One lawmaker recalled comparisons to Travelocity, the travel booking site.
In fact, the rosy presentations set President Obama up for even more criticism when the portal was swamped by millions of people who quickly found out they could not log on. The technical problems that emerged have raised questions — still not entirely answered — about how much the president’s aides knew, or should have known, about the site’s troubles.
“We knew this was a complex undertaking but did not see the huge volume of demand coming,” Mr. McDonough said in an interview this week. “And that volume has exacerbated, as the president said the other day, the underlying problems. The fact is we’ll get to the bottom of it and get it fixed.”
The issue of when administration officials recognized the Web site’s potential for major problems has emerged as one of the key political talking points on Capitol Hill. During a hearing Thursday of the House Committee on Energy and Commerce, angry lawmakers grilled executives from the private companies hired to design and build the site about whether they had warned government officials.
The executives testified that “end to end” testing of the Web site did not take place until two weeks before the site made its debut — about the same time that the briefings by Mr. Simas and Mr. McDonough were taking place. And they said problems with the software that powers the Web site were communicated to senior officials in the president’s administration.
Cheryl R. Campbell, a senior vice president of CGI Federal, a unit of the CGI Group, the main contractor on the federal exchange, said that all of her company’s work had been done “under the direction and supervision” of the federal Centers for Medicare and Medicaid Services, known as C.M.S.
Andrew M. Slavitt, the UnitedHealth executive responsible for Quality Software Services, told lawmakers that “we made everyone aware of the risks that we saw.” He added later, “We informed C.M.S. that more testing was necessary.”
Contractors Describe Limited Testing of Insurance Web Site
By ROBERT PEAR
WASHINGTON — Federal officials did not fully test the online health insurance marketplace until two weeks before it opened to the public on Oct. 1, contractors told Congress on Thursday.
While individual components of the system were tested earlier, they said, the government did not conduct “end-to-end-testing” of the system until late September.
The disclosure came at a hearing of the House Energy and Commerce Committee, which is investigating problems plaguing the federal marketplace, or exchange, a central pillar of President Obama’s health care overhaul. The hearing suggested that the team of contractors was more like an orchestra with scores of musicians playing different tunes and no conductor to lead the overall effort, set the tempo or unify the ensemble.
Lawmakers from both parties expressed anger and dismay at the contractors’ performance. The lawmakers said they felt misled because the same contractors testified at a hearing on Sept. 10 that the online marketplace was working properly and was ready to enroll millions of Americans eager to buy insurance, subsidized by the government.
The Obama administration was supposed to coordinate the work of the contractors on the federal insurance exchange. But witnesses had difficulty delineating their roles and responsibilities on the project, and they said the government was responsible for all the major decisions.
“There is a major league blame game going on,” said Representative Pete Olson, Republican of Texas.
Representative David B. McKinley, Republican of West Virginia, told the witnesses: “I haven’t heard one of you apologize to the American public on behalf of your company for the problems. Are apologies not in order? I haven’t heard the words ‘I’m sorry.’ ”
Executives from two contractors — CGI Federal, a unit of the CGI Group, and the UnitedHealth Group — said the federal Centers for Medicare and Medicaid Servicesdecided to open the exchange on Oct. 1 even though testing had raised concerns.
‘General Contractor’ Named to Fix Health Web Site
By ROBERT PEAR
WASHINGTON — In an abrupt shift, the Obama administration on Friday named a “general contractor” to fix the troubled Web site of the federal health insurance marketplace, and said the repairs would be completed by the end of next month.
In addition, Jeffrey D. Zients, President Obama’s troubleshooter for the marketplace, said that investigators had found bugs in the software that powers the site.
That finding differs from the original explanation about the problems that have crippled the Web site. Administration officials initially said that the difficulties occurred because the number of people trying to use the site far exceeded their expectations, and they played down other factors.
Julie Bataille, a spokeswoman for the federal Centers for Medicare and Medicaid Services, said the general contractor that would fix the Web site was Quality Software Services. Mr. Zients said the company would “manage the overall effort,” like a general contractor on a home improvement project.
The company “will prioritize the needed fixes and make sure they get done,” Mr. Zients said.
“The HealthCare.gov site is fixable,” said Mr. Zients, a management expert named as troubleshooter on Tuesday. “It will take a lot of work. A lot of problems need to be addressed. But let me be clear. HealthCare.gov is fixable.”
“By the end of November,” he said, “HealthCare.gov will work smoothly for the vast majority of users.”
That self-imposed deadline comes just two weeks before the Dec. 15 deadline for people to sign up for insurance that takes effect on Jan. 1.
The open enrollment period continues until March 31. People who go without insurance after that date may be subject to tax penalties.
However, the chaos and confusion with the federal marketplace have prompted some Democrats and many Republicans to suggest that the penalties should be deferred or the enrollment period extended.
Just What Is an 834 Transaction? Why Is It Holding Up Obamacare? How Long Will This Take to Fix?
You have probably already heard that Obamacare has as many backroom problems as problems with the front end consumer web enrollment portal.Insurance companies participating in the new health insurance exchanges are receiving detailed enrollment information for each of the very few people who have successfully enrolled through the 36 federally run health insurance exchanges.
But the problem is that this enrollment is coming from the government with a very high rate of errors––way beyond anything they can handle manually once the real enrollment volume comes in.
So long as each insurance company is receiving only 10 or 20 enrollments a day––that is what they are receiving now––the high error rate enrollments can be fixed with lots of hands-on effort. If the Obama administration fixes the consumer portal before fixing the 834 problem, the insurance companies could begin receiving thousands of enrollments with high error rates every day. That would bring the insurance company information technology departments to their knees. It would mean lots of new policyholders could have problems getting their bank accounts properly debited, their claims held up, or health care providers refusing to treat them because they aren't on the list of covered people.
So this is a very big deal.
New Year’s Baby? You May Pay More
By ELISABETH ROSENTHAL
Traditionally, much hoopla surrounds the birth of the first baby of the New Year. But it turns out that can be an expensive bit of good luck.
While medical conditions and encounters don’t care whether it’s 2013 or 2014, health insurance and subsidies generally play by the calendar year. Deductibles reset on Jan. 1, no matter if you began your six weeks of radiation in December or have been pregnant for the last eight months. And with more and more policies, including those offered under the Affordable Care Act, carrying high annual deductibles of $2,000 or more, that reset can lead to major expenses for consumers who must fulfill the new deductible.
I have spent this year covering medical pricing and have received comments from a number of patients who fell victim to this deductible double jeopardy. Jennifer from Evanston, Ill., wrote:
“My 2nd pregnancy spanned two calendar years, so despite the fact that it was the same pregnancy, I paid my deductible twice, and 20 percent of the hospital charges.”
This year, the beginning of the Affordable Care Act health exchanges may amplify the problem for some patients as they switch to new insurance. Rebecca wrote:
“My State Insurance is switching to ObamaCare, and my deductibles start ALL over again with no option to dispute my prenatal and birthing care as an extension of existing care. So, $4,000 deductible and now another $3,000 for the last month and birth.”
Unfortunately, that is how insurance works. “Deductibles accumulate on an annual basis, so claims for 2013 accrue until December 31st and then start again for 2014,” said Susan Pisano, vice president of communications for America’s Health Insurance Plans, a trade group. She noted also that insurance companies generally do their accounting according to when a claim was submitted, not when the service occurred.
This double jeopardy can prove extremely costly in a country where even routine pregnancies ending in simple vaginal delivery can cost $15,000. It may also be burdensome to patients undergoing prolonged or complicated treatment, like breast surgery followed by reconstruction.
Should Medical School Last Just 3 Years?
By PAULINE W. CHEN, M.D.
Sandwiched between three mind-numbing years of basic science courses and hospital rotations and the lockdown years of residency training, the fourth year of medical school has long been a welcome respite for future doctors. It is the only time in their medical education when students have few requirements and a plethora of elective course offerings – and the time to go on vacation and spend time with friends and family.
“Do it now,” a mentor said as I was about to start my last year, “because you may never get the chance again.”
I followed that advice wholeheartedly. I spent most of my fourth year away from my medical school, caring for children with hematologic disorders one month, then shadowing cancer surgeons for another, in hopes of figuring out which specialty I liked more. I spent time working in a laboratory, something I’d never done before, learning how to culture and freeze cells, care for mice, and critique studies. I attended national medical meetings, hung out with old friends, and slept and ate to my heart’s content at my parents’ home.
For me, it was a pivotal, reassuring year.
But not all of my classmates felt the same. One friend interested in a particularly competitive residency spent much of the year in high-stress “audition clerkships,” four-week clinical tours at hospitals where she hoped to train; she resented having to pay tuition at our home school while paying travel and living expenses so she could learn at other institutions. Another, older classmate, who had already spent 10 successful years in another profession, was just eager to get on with his training; for him, a fourth year filled with electives and extended vacations was a waste of time and tuition money.
“The fourth year is kind of bogus,” one friend recently recalled. “It might have been fun at the time, but I’m not sure it made me a better doctor.”
These disparate opinions came to mind recently when I read two perspective pieces in The New England Journal of Medicine on eliminating the fourth year of medical school.
For several years, medical educators have been engaged in an increasingly heated, and occasionally cantankerous, debate about streamlining medical education and training. Many experts have suggested lopping years off the residency training process, but surprisingly few have argued for such similarly dramatic changes in the medical school curriculum.
The Not-So-Hidden Cause Behind the A.D.H.D. Epidemic
By MAGGIE KOERTH-BAKER
Between the fall of 2011 and the spring of 2012, people across the United States suddenly found themselves unable to get their hands on A.D.H.D. medication. Low-dose generics were particularly in short supply. There were several factors contributing to the shortage, but the main cause was that supply was suddenly being outpaced by demand.
The number of diagnoses of Attention Deficit Hyperactivity Disorder has ballooned over the past few decades. Before the early 1990s, fewer than 5 percent of school-age kids were thought to have A.D.H.D. Earlier this year, data from the Centers for Disease Control and Prevention showed that 11 percent of children ages 4 to 17 had at some point received the diagnosis — and that doesn’t even include first-time diagnoses in adults. (Full disclosure: I’m one of them.)
That amounts to millions of extra people receiving regular doses of stimulant drugs to keep neurological symptoms in check. For a lot of us, the diagnosis and subsequent treatments — both behavioral and pharmaceutical — have proved helpful. But still: Where did we all come from? Were that many Americans always pathologically hyperactive and unable to focus, and only now are getting the treatment they need?
Probably not. Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.
Which is not to say that A.D.H.D. is a made-up disorder. In fact, there’s compelling evidence that it has a strong genetic basis. Scientists often study twins to examine whether certain behaviors and traits are inborn. They do this by comparing identical twins (who share almost 100 percent of the same genes) with fraternal twins (who share about half their genes). If a disorder has a genetic basis, then identical twins will be more likely to share it than fraternal twins. In 2010, researchers at Michigan State University analyzed 22 different studies of twins and found that the traits of hyperactivity and inattentiveness were highly inheritable. Numerous brain-imaging studies have also shown distinct differences between the brains of people given diagnoses of A.D.H.D. and those not — including evidence that some with A.D.H.D. may have fewer receptors in certain regions for the chemical messenger dopamine, which would impair the brain’s ability to function in top form.
More legal trouble for Affordable Care Act
Critics of Obama's healthcare plan are suing over a part of the law that offers tax credits through state exchanges. If they win, the program falls apart in 36 states.
By David G. Savage
5:00 AM PDT, October 25, 2013
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WASHINGTON— If computer glitches are not enough of a problem, President Obama's healthcare law also has a legal glitch that critics say could cause it to unravel in more than half the nation.
The Affordable Care Act proposes to make health insurance affordable to millions of low-income Americans by offering them tax credits to help cover the cost. To receive the credit, the law twice says they must buy insurance "through an exchange established by the state."
But 36 states have decided against opening exchanges for now. Although the law permits the federal government to open exchanges instead, it does not say tax credits may be given to those who buy insurance through a federally run exchange.
Apparently no one noticed this when the long and complicated bill worked its way through the House and Senate. Last year, however, the Internal Revenue Service tried to remedy it by putting out a regulation that redefined "exchange" to include a "federally facilitated exchange." This is "consistent with the language, purpose and structure … of the act as a whole," the Treasury Department said.
ut critics of the law have seized on the glitch. They have filed four lawsuits that urge judges to rule the Obama administration must abide by the strict wording of the law, even if doing so dismantles it in nearly two-thirds of the states. And the Obama administration has no hope of repairing the glitch by legislation as long as the Republicans control the House.
This week, U.S. District Judge Paul Friedman in Washington, a President Clinton appointee, refused the administration's request to dismiss the suit. Instead, he said the challengers had put forward a substantial claim, and he promised to issue a written ruling.
"This is a problem," said Timothy Jost, a law professor at Washington and Lee University. "This case could have legs," although "it was never the intent of Congress to establish federal exchanges that can't do anything. They were supposed to have exactly the same powers."
Michael Carvin, the Washington lawyer leading the challenge, says the wording of the law is what counts. "This is a question of whether you believe in the rule of law. And the language here is as clear as it could possibly be," he said.
http://www.latimes.com/nation/la-na-healthcare-glitch-20131025,0,5361506,print.story
Addicted to the Apocalypse
By PAUL KRUGMAN
Once upon a time, walking around shouting “The end is nigh” got you labeled a kook, someone not to be taken seriously. These days, however, all the best people go around warning of looming disaster. In fact, you more or less have to subscribe to fantasies of fiscal apocalypse to be considered respectable.
And I do mean fantasies. Washington has spent the past three-plus years in terror of a debt crisis that keeps not happening, and, in fact, can’t happen to a country like the United States, which has its own currency and borrows in that currency. Yet the scaremongers can’t bring themselves to let go.
Consider, for example, Stanley Druckenmiller, the billionaire investor, who has lately made a splash with warnings about the burden of our entitlement programs. (Gee, why hasn’t anyone else thought of making that point?) He could talk about the problems we may face a decade or two down the road. But, no. He seems to feel that he must warn about the looming threat of a financial crisis worse than 2008.
Or consider the deficit-scold organization Fix the Debt, led by the omnipresent Alan Simpson and Erskine Bowles. It was, I suppose, predictable that Fix the Debt would respond to the latest budget deal with a press release trying to shift the focus to its favorite subject. But the organization wasn’t content with declaring that America’s long-run budget issues remain unresolved, which is true. It had to warn that “continuing to delay confronting our debt is letting a fire burn that could get out of control at any moment.”
As I’ve already suggested, there are two remarkable things about this kind of doomsaying. One is that the doomsayers haven’t rethought their premises despite being wrong again and again — perhaps because the news media continue to treat them with immense respect. The other is that as far as I can tell nobody, and I mean nobody, in the looming-apocalypse camp has tried to explain exactly how the predicted disaster would actually work.
On the Chicken Little aspect: It’s actually awesome, in a way, to realize how long cries of looming disaster have filled our airwaves and op-ed pages. For example, I just reread an op-ed article by Alan Greenspan in The Wall Street Journal, warning that our budget deficit will lead to soaring inflation and interest rates. What about the reality of low inflation and low rates? That, he declares in the article, is “regrettable, because it is fostering a sense of complacency.”
G.O.P. Roots for Failure
By JULIET LAPIDOS
In theory, lawmakers hope that government programs work well, and if they don’t, try to fix them. In theory, our representatives hope that government agencies carry out their missions smoothly, and if something goes wrong, try to figure out what happened to avoid making the same mistake in the future.
Obviously that’s not how things work in the United States, where one of the two parties doesn’t even believe in government. Republicans want to shrink government until it’s small enough to drown in a bathtub! They think there’s nothing scarier than the prospect of a government employee trying to help! With beliefs like those, it’s not surprising that — with disturbing frequency — they root for failure in order to score points.
Examples abound. After the attack in Benghazi, G.O.P. lawmakers were far more interested in laying blame and making the Obama administration look bad than in improving security for diplomats. In the midst of the I.R.S. scandal — which turned out not to be much of a scandal at all — Republicans seemed positively gleeful.
Which brings us to today’s House hearing on the bumpy rollout of the federal health insurance marketplace.
Which brings us to today’s House hearing on the bumpy rollout of the federal health insurance marketplace.
The rollout is bumpy, and inexcusably so. It appears that the federal exchange Web site wasn’t fully tested until two weeks before it opened. As today’s Times story put it, the online health insurance marketplace “is still limping along after three weeks.”
Lawmakers can and should hold the administration to account. But given that House Republicans have done everything in their power to try to dismantle the Affordable Care Act — including shutting down the entire government — it’s understandable that House Democrats expressed suspicion about their motives.
“I wish I could believe that this hearing is above board, but it’s not,” said Representative Frank Pallone, Democrat of New Jersey. “The Republicans don’t have clean hands coming here. Their effort is obviously not to make this better, but to use the website glitches as an excuse to defund or repeal Obamacare.”
Taking the same line, Representative Henry Waxman, Democrat of California, said: “We have already documented a record of Republicans attempting to sabotage the Affordable Care Act.” He added, “If we want this law to work, we have to make this right; we’ve got to fix it. Not what the Republicans are trying to do: nix it and repeal it.”
Although some Republicans asked valid and thoughtful questions of the private contractors who’d come to testify, others seemed to prove Mr. Pallone and Mr. Waxman right.
The wildest time ever in American health care
Posted Oct. 24, 2013, at 12:16 p.m.
The American health care industry has fallen down an “Alice in Wonderland” rabbit hole, and awakened in the strangest, wildest time in its history. Hospitals are spending millions of dollars trying to keep patients from being admitted to them, and health systems are becoming insurance companies. In turn, insurance companies are buying hospitals and physician groups so they can take care of patients and thereby, perhaps, finally control the costs of patient care. The way things are going, McDonald’s will soon be treating my high cholesterol while I wait for my fries.
These are times of epic change for America’s biggest industry, all the result of America’s decision it can no longer afford the industry we built into its biggest. These change are far more fundamental than the managed care frenzy of the ’90s. The health care industry is Detroit’s Big Three car makers with Japan about to eat our lunch, the record industry about to get warped by digital music, the airline industry about to fly into the mountainside of deregulation, and the book industry reading a horror novel titled “Amazon and Kindle Eat You Alive.”
Like those industries, traditional business models on which most of the industry is based are being torn apart. The piecework model of getting paid more money to provide more care — the basic model for almost every doctor, hospital and other provider of health care in America for more than a hundred years — is slowly dying. What will replace it remains unclear, but will probably involve us all getting paid more if we keep patients healthier and spend less patient money but more effectively. The problem is, most of us managing the industry don’t yet know how to make enough money in that new model to keep our patient care businesses viable. Every step we take to build for that new model costs us money we don’t have, may reduce what we get paid during the change, and feels like trying to live underwater before we grow gills.
As part of this massive retooling, where you get your health care is being turned on its head. CVS pharmacies are now providing free health screenings at some of their stores, and you can shop for urgent care at Walmart. Big employers are putting family physician offices in their buildings for their employees. Some physicians are now providing Internet and email-based “e-visits” to patients with simple medical problems that can be treated without the inconvenience of the call-your-doctor-and-wait-two-weeks-to-be-seen model of care. Most of the care hospitals provide now is outside the traditional hospital room with its two patient beds separated by a curtain.
No part of the industry will be more affected than hospitals, which have been the epicenters of the industry for the last 70 years and are now becoming its cost centers. More and more care is moving away from them, more and more money is being invested trying to keep people out of them, and the locus of control in health care is moving away from them. Giants of the hospital industry are making dramatic changes to adopt; the Cleveland Clinic — perhaps the most successful hospital company in America — is going to cut its workforce by thousands and stop paying doctors more money just to see more patients. It is investing millions of dollars in approaches to patient care substantially different from those that have been its core businesses; on a smaller scale, so is almost every other hospital in America.
As a result of those changes in hospitals, many health care experts are predicting that in another 10 years most American hospitals will be owned by a small number of big health care systems, and that the traditional small community hospital will be part of a larger system or part of history.
In Ohio, Obamacare fight renewed as GOP governor and activists tussle
By Cathleen Decker
3:49 PM PDT, October 23, 2013
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It is the center of the political universe in presidential contests. And now the war over the nation’s new healthcare program has come to Ohio as well, with potential repercussions for the short- and long-term future of the state’s governor, John Kasich.
Kasich has been feuding with some of his fellow Republicans over whether to expand the Medicaid insurance program for state residents, under terms of the healthcare plan. GOP lawmakers stripped the expansion from the state’s budget, prompting an end-run by Kasich to the state’s obscure Controlling Board, which on Monday approved the expansion. (The board normally doesn’t deal with matters as fraught as the multimillion-dollar federal benefit under Obamacare.)
By Wednesday, the matter was in the courts, after a conservative legal group filed suit to block the expansion on behalf of six legislators and two anti-abortion groups.
“Our lawsuit stands for the simple proposition that neither this governor nor any other is a king," Maurice Thompson, executive director of the 1851 Center, which filed the lawsuit, said in a statement. "For government to be limited, the making of transformational public policy requires the assent of the Ohio General Assembly, and cannot be done through administrative overreach. This occasion requires Ohioans to draw a line in the sand and affirm that we'd rather not bring Washington, D.C.- style decision-making to Ohio."
Kasich, who could not be reached for comment, is not the only Republican governor to favor expanding the reach of Medicaid. Among others, Michigan Gov. Rick Snyder and Arizona’s Jan Brewer earlier backed the Medicaid expansion despite arguments from some in their party that any breach in the wall of opposition to President Obama's healthcare plan was intolerable. All have argued that federal coverage for poor residents -- whose care otherwise lands in the fiscal lap of local hospitals and governments -- benefited their states.
The Ohio governor’s latest move inflamed relations with the conservative group Americans for Prosperity, whose president, Tim Phillips, called the Controlling Board move “outrageous.”
“Republican majorities, in the end, said we don’t think this is good for the folks in our state or for taxpayers,” he said in an interview with the L.A. Times’ Maeve Reston. “ We think it’s pretty outrageous that a governor would then go around the elected representatives of the people and go to an unelected board.”
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